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We need to talk about how PTSD affects women too

“I lived in constant fear, but could never articulate what I was afraid of. My memories, the pain attached to the past, my current loneliness and fears for the future were so tightly entwined it seemed impossible to unravel. I didn’t trust anyone, and I pushed everyone around me away.”

Andrea* is one of an estimated 3–10% of people who will be affected by Post-Traumatic Stress Disorder (PTSD) at some point in their lifetime. The condition involves recurrent distressing memories, flashbacks and nightmares of a traumatic experience, and was first diagnosed in soldiers returning from war.

During World War One it was known as ‘shell shock’ and, although psychiatrists’ understanding of the condition has come a long way since then, the association with the armed forces means that many people continue to think of PTSD as a largely male condition, inflicted on servicemen by the horrors of war.

But Andrea has never fought in armed conflict, and the only war zone she’s survived was inside her own home. Indeed, the prevalence of PTSD is estimated to be roughly equal across genders, while women aged 16-25 are the highest risk group, with a prevalence of 12.6 per cent.

Gendered differences

Despite this, a survey by charity Agenda, the alliance for women and girls at risk, as part of their Women in Mind campaign, found that one in three people believe PTSD is more likely to by experienced by men, compared to just 9% who thought it was more likely to affect women.

Counsellor Zoe Hawton specialises in trauma and believes that PTSD is massively under-diagnosed because she thinks “most of the public only associate it with veterans, who are presumed male”.

Instead, for Andrea, the cause was six years of sustained domestic abuse – emotional, mental, financial, physical, and sexual. “Whilst physical violence was present, and used more often towards the end of the relationship, rape and sexual abuse was the form of control most often used,” she says.

“Broadly, men are more likely to ‘externalise’ trauma, through aggression and sometimes violence, while women often ‘internalise’ trauma, resulting in higher rates of self-harming and eating disorders, or turning to drugs and alcohol as coping mechanisms.”

“He knew that sexual violence is difficult to prove in a marriage and, because I rarely had signs of being abused – like cuts, bruises or black eyes – there was no ‘evidence’ for me to seek help.”

“There is a serious lack of understanding of the impact abuse and trauma have on women’s mental health,” says Katharine Sacks-Jones, Director of Agenda. “More than half of women who have a mental health problem have experienced abuse, but this often goes unrecognised. Broadly, men are more likely to ‘externalise’ trauma, through aggression and sometimes violence, while women often ‘internalise’ trauma, resulting in higher rates of self-harming and eating disorders, or turning to drugs and alcohol as coping mechanisms,” she explains.

“When women do externalise trauma, especially in settings that are not trauma or gender-informed, they are often misdiagnosed, or labelled as ‘difficult’ or ‘attention-seeking’,” Ms Sacks-Jones adds.

Complex trauma

For Iranian refugee Zahara*, trauma took several different forms, making her PTSD complex and deeply rooted. As a child she witnessed domestic violence, and the imprisonment of her activist father. While living in Pakistan as a child refugee, she experienced several instances of sexual violence and abuse, and later encountered both honour-based violence as a student, and workplace sexual harassment during her 30s.

What is often also overlooked in conversations around PTSD is that violence is not the only possible cause. While conflict, domestic and sexual violence are huge contributing factors, PTSD can be caused by experiencing or witnessing any perceived or actual risk of death or injury.

“The experience at work triggered major panic attacks and anxiety but, prior to this, during my childhood and late twenties, the trauma manifested itself in the form of feeling numb and detached from myself. I could never be alone, and constantly found myself getting into self-destructive patterns like abusive relationships, self-harm, and substance abuse,” she explains.

“When I was in Pakistan as a child, I pulled out my two front teeth because I thought it would make me less sexually attractive, and I’ve had issues with sleep and eating, and terrible nightmares, for as long as I can remember,” Zahara adds.

Other factors that can cause PTSD

What is often also overlooked in conversations around PTSD is that violence is not the only possible cause. While conflict, domestic and sexual violence are huge contributing factors, PTSD can be caused by experiencing or witnessing any perceived or actual risk of death or injury – from a natural disaster to being told you have a life-threatening illness.

Approximately 10,000 women a year develop PTSD following a traumatic childbirth, and as many as one in three teens who survive serious car accidents may be affected by the condition. Catherine* was 15 when she experienced a road traffic collision, and spent the following 15 years grappling with anxiety, panic attacks, intrusive memories, and avoidance of any situation that reminded her of the accident.

“I found it difficult to get in the back of a car, drive in the country or at high speeds, or see ambulances or other car accidents,” she explains. “I tried to block it out, but I was triggered by so many things and all the details would come flooding back.”

Treatment and support

Anyone affected by PTSD can access support, including medication and talking therapies, through their GP, or contact PTSD UK for more specialised advice. The most commonly used therapies for PTSD are Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR), and women with experiences like Andrea and Zahara may also benefit from specialist domestic and sexual violence services, like Rape Crisis and Women’s Aid.

*Names have been changed

Featured image shows a woman looking straight at the camera being comforted by another woman. The image is cropped so you can only see their faces.

Sarah Graham

Sarah Graham is a freelance health journalist, specialising in mental health and women’s sexual/reproductive health. She was previously communications executive at Women for Refugee Women, and before that was Deputy Editor of Feminist Times. She’s particularly interested in exploring the areas where health and feminism overlap, from the health implications of gender inequality – such as abortion rights, male suicide rates, and the mental health impact of violence against women – to sexism and male-centric approaches in healthcare research and support.